Despite proven results in industry, quality improvement and safety implementation lags in the health care arena. Improving patient safety and quality of care requires an understanding of leadership, teamwork, system design and function, change motivation, and a scientific/statistical approach to assessing whether changes are leading to improvement.

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At 2 am on July 2, a pediatric intern enters room 4 of the emergency department (ED) to see his next patient. He encounters 4-year-old Aiden, whom his parents report has not been feeling well for a few days. In addition, they report decreased oral intake. Aiden is communicative but listless. His extremities are cold, he has delayed capillary refill, and he has weak pulses. His heart rate is 140 beats per minute and blood pressure is 80/50 mm Hg. The intern decides that Aiden is dehydrated and submits electronic orders for the nurse...

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